Nurses can help drive strategies that affect cost and quality "because they deal with it every day," says an RN and veteran member of multiple boards. Yet nurses—especially women—are grossly underrepresented on hospital boards.
Here's a question for you, hospital executives: Why don't you have a nurse on your board?
To the handful of you who actually do have a nurse on the board of directors, kudos. But the chances are good that you don't have one: data from 2011 shows that only 6% of board members are nurses.
Gender is certainly a contributing factor here. Most nurses are women, and in general, women are grossly underrepresented on corporate boards across industries. According to data from Catalyst, women hold just 16.9% of board positions in the United States.
"If it were proportional, it would be 52%," says Connie R. Curran, RN, EdD, FAAN, CEO of Best on Board. She serves on boards of directors for Hospira, Inc., DePaul University, and the University of Wisconsin Foundation. Curran was also the former chairperson of the board of Silver Cross Hospital in Lenox IL, and has served on many others.
She has lots of experience, not only with being the only nurse and the only woman on a board, but also with encountering blatant sexism along the way.
Curran was once appointed to the finance committee of a board, she learned later, because the hospital's CFO assured the CEO: "She's a dumb blonde. Give her to me, she won't cause any trouble."
Sexism is certainly a way of life. But equity for the sake of it is not the reason hospitals should work to get more nurses on their boards. They should do it because it makes good business sense.
Strategy, Not Management
"The purpose of a board is to oversee, to provide guidance," Curran says. "It's not to manage. It's to provide strategy, and in the case of hospitals, it is to make sure you're meeting the needs of the community and stakeholders."
Curran remembers how one hospital board she sat on was in the midst of approving several quick budget cuts. One of the planned cuts was to close the hospital's pharmacy on the weekends; it was something the other board members thought was a good idea.
"They were all about to say yes when I raised my hand and said, 'How will the meds get up to the units?'" Curran says.
The pharmacist will get them ready Friday night, she was told. But what about medication changes? Emergencies throughout the weekend? Well the nurses can handle that, said proponents of the change.
Curran explained that nurses don't practice pharmacy, and moreover, they shouldn't leave the unit during their shifts, especially on weekends when the hospital operated with a skeleton crew.
In the end, the pharmacy didn't close on the weekends, and the anecdote illustrates how important it is for board members to understand the real workings of a hospital. Too often, board members, even if they are physicians, don't understand the practicalities of how a hospital operates. The board needed a nurse to get that crucial perspective.
"I think nurses understand a lot of the practical things that affect cost and quality because they deal with it every day," Curran says.
She says she often hears excuses about why nurses aren't on boards, ranging from "I never thought of it" to "Where do I find a nurse?" Here are three of those excuses, busted:
1. "I never thought of it."
In her book Lean In: Women, Work, and the Will to Lead, Sheryl Sandberg, COO of Facebook, writes that there was no designated parking for pregnant women in Google's huge parking lots. Her male bosses weren't being intentionally insensitive, they just had never been pregnant before, and didn't know such a thing was needed.
So Sandberg asked for it, and got it. If you're a hospital executive who's never thought to have a nurse on the board, consider this your "Lean In moment." And "if you're a CNO, you should be bugging your board about getting a nurse," Curran says.
2. "Where do I find a nurse?"
"The average hospital board is about 12 people, and typically 20%–30% of those people are physicians," Curran says. There are 3.1 million nurses in the United States, so if you can find a physician for your board, you can find a nurse.
Look to places like nursing schools or hospitals in neighboring areas that don't compete with yours. "Boards meet about six times a year and there are 5,000 hospitals in this country," Curran says. Hospitals who put in even a little bit of effort can find a nurse for their board.
3. "Are nurses qualified?"
"Nurses maybe are not viewed as being affluent enough," to sit on a board, says Curran, especially since some boards are upfront about expecting their members to donate. But nurses who don't have deep pockets can help the board in other ways that are just as valuable, and arguably more so, since their knowledge of how hospitals operate can contribute meaningfully to the board's decisions.
Many boards have a banker and a lawyer at the table, Curran points out, and if they're qualified to help guide a hospital, a nurse certainly is, too.
The healthcare industry is getting more complicated by the day, so it's more important than ever for hospitals and executives to show their business savvy and choose board members who truly represent the interests of the organization and its stakeholder. The days of near-lifetime, "who-you-know" appointments to hospital boards will no longer cut it in such an environment, Curran says.
"It's not the old boys club anymore," she says. "We really need board members who are passionate about patient care and are willing to roll up their sleeves and work hard on behalf of patients."
Alexandra Wilson Pecci is an editor for HealthLeaders.
